PT 2012: Where Does PT Fit in Health Care Reform?

Tampa-One overriding theme at PT 2012 has been keeping the profession at the forefront of health policy change. Most therapists agree that there are many ways they need to make that happen-through better data tracking, research, advocacy and education of stakeholders in health care as to how vital physical therapy is to positive health care outcomes.

And who better to explain how the profession plays a major role than an admitted "outsider." Everette James, JD, MBA, former Pennsylvania Secretary of Health, was keynote and moderator for the 2012 Rothstein Roundtable: Medical Homes, PACA, IFDS-Where do Physical Therapists Fit in a Reforming Health Care Environment? held Friday.

James, who oversaw the regulation of hospitals, nursing homes and managed care plans in his state, now advises on health reform implementation and leads the collaborative Comparative Effectiveness Research program. He had the full attention of a packed room of attendees while he questioned the panel on changes they have successfully made to solidify PT's place in health management.

Carolyn Oddo, PT, FACHE, vice president for operations support/associate administrator at Harris County Hospital District in Houston, TX, and Stacey Cochran-Comstock, PT, DPT, CSCS, physical therapist at Providence Portland Medical Center, Portland, OR, shared the details of what worked for their respective health systems.

James noted that the state of Pennsylvania was the first to license PTs-in 1913, "it took us 90 years later to update laws relating to PT scope of practice," he said. "It took us until 2002 to gain direct access in the state and in 2008 the state expanded the definition of PTs and PTAs. We are still a limited direct access state," he pointed out. "Each state needs to address the many barriers to direct access. Credentialing? Hospitals?"

James challenged therapy providers to consider interdisciplinary care options and to identify potential partners to PT to combine with other professions in delivery care. "Who are those natural partners? Can you imagine a primary care model where all related clinicians are involved" at the earliest stages of care," he asked.

The more clinicians involved at the start point of care, Oddo noted, the less many patient populations will need Medicaid coverage for turning to emergency rooms for care that MDs, PTs and even pharmacists can provide. "Other professions solidify their roles in care and we need to do the same," she said, noting conditions such as low-back pain are a top PT diagnosis and should begin with therapists at the outset.

Cochran-Comstock agreed. "I think Medicaid changes might be the sleeper here," she said. "In Oregon we are focusing on those with chronic pain and "frequent flyers"-those visiting ERs multiple times for pain treatment. We are trying to change our system to treat these patients differently."

Anthony Delitto, PT, PhD, FAPTA, professor of physical therapy at the University of Pittsburgh, stressed that for a primary care "dream team" to be possible, evidence-based practice must be followed-and it is something the profession needs to consider when confronted with chiropractors and others who angle to provide patients with similar services. "In our system, we can't just demand that patients see us first when they also have the option of a chiropractor; we have to come to the door with our evidence-based practice."

Oddo stressed that patients ultimately need to know who is on their care team. "Our medical homes are really community health centers; all professions involved are represented in one building with primary care doctors. Our goal here is to take care of what each patient needs right there, rather than referring to someone else, in another office who they may not even get an appointment to see. Ideally, a doctor will be able to diagnose a problem and send the patient to who [he] needs to see that very day."